An increasing number of surgical techniques are now performed arthroscopically. One type of arthroscopic procedure reconstructs the anterior cruciate ligament (ACL) in the knee. Several ACL reconstruction techniques are described in U.S. Pat. No. 5,139,520 (Rosenberg), which is incorporated herein by reference. The replacement ACL graft is selected, according to surgeon preference, from a portion of a patellar tendon having a bone block or plug at each end, a semitendinosus graft which is whip-stitched with suture at each end, a fully prosthetic device, or a combination of artificial and natural material such as a ligament augmentation device (LAD) to which tissue is sutured. The term "graft" is used herein to encompass all of these tissue replacement items.
Presently, different attachment devices are used to secure those various grafts in position. The bone block portions of patellar tendon grafts are typically fixated in the femoral tunnel or channel using a headless interference screw. If the graft bone block or the femoral bone lacks sufficient structural integrity, however, this procedure may not be advisable. Further, there is a possibility that the screw could shift in position a number of months or years after implantation which may interfere with joint movement or integrity. Additionally, the screw physically blocks bone tissue from growing into the graft to naturally secure it within the femur.
Semitendinosus grafts are typically fixated using a circular button-type fixation device which is implanted through the outer side (lateral) surface of the leg above the knee. This implantation requires an ancillary lateral incision through the skin and quadriceps muscle which increases the trauma to the leg and is, at the least, cosmetically undesirable. Moreover, time must be taken during the surgical procedure to tie sutures from the graft to the button-type device, which extends the length of the overall operation.